Anti-Corruption Screening Form

(to be completed by in-scope applicants as defined in the Anti-Corruption HR Screening Plan, v.2020)
Notice to Applicants: The information collected herein is part of the application process, is being collected to
determine if you have any conflicts of interest that may present a corruption risk or an appearance of
improper influence for the position that you are applying for, and the Company reserves the right to ask for
additional information beyond what is asked in this application. Furthermore, by completing this application,
the applicant agrees that if subsequent developments cause the information reported herein to be no longer
accurate or complete, the applicant will immediately notify the Company regarding a change in
circumstances. By providing this information, the applicant certifies that the statements and information
contained in this submittal are true, accurate, and complete. Any misrepresentation or concealment of
information may result in the employment termination in accordance with market-specific policies.

The information collected on this form is used for recruiting and employment purposes.

1. Have you been employed by a Government Entity within the last two years, or are you
currently employed by a Government Entity, or do you anticipate holding a government
position/title within the next 12 months?
A Government Entity is any government department, agency, ministry, instrumentality, entity, political
party, political campaign, state-owned enterprise, public international organization, recognized
traditional or tribal council, or recognized traditional or royal family. In the case of political party
candidacy or position, please state the office for which you are running or hold/held (ex. mayor), but do
not identify the political party affiliation.
YES NO
If “YES”, provide the information regarding past/current/future government employment below
(attach list on a separate page, as needed):

For Past Employment (Last Two Years)

Please identify the Government Entity that employed you: NA

___________________________
Please identify the position/title you held with the
Government Entity: Na
___________________________________
Please identify the dates that you were employed
by the Government Entity: Na
____________________________________
Please identify the City where the Government
Entity is located: Na
___________________________________

For Current Government Positions

Please identify the Government Entity that employs you: Na
____________________________
Please identify the position/title you hold with the
Government Entity: Na
_____________________________
Please identify the City where the Government
Entity is located: Na
______________________________

For Future Government Positions (Future 12 Months) mark “N/A” if future employment is not known
Please identify the Government Entity that you anticipate holding a position/title with
within the next twelve months: Na
________________________________________________
Please identify the government position/title that you anticipate holding
within the next twelve months: Na
_______________________________________________

Page 1 of 2 Effective from 1 st April 2020

 Anti-Corruption Screening Form
(to be completed by in-scope applicants as defined in the Anti-Corruption HR Screening Plan, v.2020)
Notice to Applicants: The information collected herein is part of the application process, is being collected to
determine if you have any conflicts of interest that may present a corruption risk or an appearance of
improper influence for the position that you are applying for, and the Company reserves the right to ask for
additional information beyond what is asked in this application. Furthermore, by completing this application,
the applicant agrees that if subsequent developments cause the information reported herein to be no longer
accurate or complete, the applicant will immediately notify the Company regarding a change in
circumstances. By providing this information, the applicant certifies that the statements and information
contained in this submittal are true, accurate, and complete. Any misrepresentation or concealment of
information may result in the employment termination in accordance with market-specific policies.

The information collected on this form is used for recruiting and employment purposes.
Please identify the City where the
Government Entity is located: Na
________________________________________________

2. Do you have any family members who are Government Officials or are employed by a
Government Entity?

Family members include parents, children, siblings, spouses, and spousal equivalents. A Government
Official is: (i) any officer or employee of a Government Entity; (ii) any person acting in an official
capacity for or on behalf of a Government Entity; or (iii) any candidate for a public office position or
any person acting in an official capacity for or on behalf of the candidate; or (iv) any officer or
employee of a private bank.

YES NO

If “YES”, provide the information regarding your family member(s) below (attach list on a
separate page, as needed):

Family Member 1
Deputy Director
Position/Title Held by Family Member 1: __________________________________________
Government Entity that Family Member 1 is
MP state Government Finance Deptartment
Employed By or Affiliated With: _________________________________________________
Please identify your relation to the
Family member who is a Government Official
Father
or employed by a Government Entity: ___________________________________________

If “YES”, are these family members in a position that interacts or could interact with the

Company?”

YES NO

Pankaj Gupta
Applicant Name: ________________________________________________
printed

Signature: ______________________________________________________
must be signed in ink

Date: 29th June 2021

________________________________________________
Page 2 of 2 Effective from 1 st April 2020